No improvement of survival with reduced- versus high-intensity conditioning for allogeneic stem cell transplants in Ewing tumor patients.

BACKGROUND: Outcomes of Ewing tumor (ET) patients treated with allogeneic stem cell transplantation (allo-SCT) were compared regarding the use of reduced-intensity conditioning (RIC) and high-intensity conditioning (HIC) regimens as well as human leukocyte antigen (HLA)-matched and HLA-mismatched grafts. PATIENTS AND METHODS: We retrospectively analyzed data of 87 ET patients from the European Group for Blood and Marrow Transplantation, Pediatric Registry for Stem Cell Transplantations, Asia Pacific Blood and Marrow Transplantation and MetaEICESS registries treated with allo-SCT. Fifty patients received RIC (group A) and 37 patients received HIC (group B). Twenty-four patients received HLA-mismatched grafts and 63 received HLA-matched grafts. RESULTS: Median overall survival was 7.9 months [±1.24, 95% confidence interval (CI) 5.44-10.31] for group A and 4.4 months (±1.06, 95% CI 2.29-6.43) for group B patients (P = 1.3). Death of complications (DOC) occurred in 4 of 50 (0.08) and death of disease (DOD) in 33 of 50 (0.66) group A and in 16 of 37 (0.43) and 17 of 37 (0.46) group B patients, respectively. DOC incidence was decreased (P < 0.01) and DOD/relapse increased (P < 0.01) in group A compared with group B. HLA mismatch was not generally associated with graft-versus-Ewing tumor effect (GvETE). CONCLUSIONS: There was no improvement of survival with RIC compared with HIC due to increased DOD/relapse incidence after RIC despite less DOC incidence. This implicates general absence of a clinically relevant GvETE with current protocols.

Visceral manifestation of cat scratch disease in children. A consequence of altered immunological state?

A 12-year-old girl with a 2-month history of fever and abdominal pain was admitted to our hospital. Ultrasound and CT scans of the abdomen showed multiple hypoechoic lesions of liver and spleen. Screening for zoonosis revealed high positive titers to Bartonella henselae. T-cell deficiency was demonstrated and remained almost unchanged during a follow-up of 11 months. A review of the literature shows that disseminated visceral affection is a rare presentation of cat scratch disease (CSD) in childhood and adolescence. Further immunological investigations are needed in more patients with CSD to confirm whether an altered immunological state may be responsible for the atypical visceral manifestation of CSD.

Depression in children with cancer.

The results of a standardized evaluation of the occurrence of depression in a group of 34 children suffering from cancer are presented. The children (13 male, 21 female) were admitted to the oncological unit of the Department of Pediatrics at the University of Graz, Austria, during a 14 months-course (January 1987-March 1988). We rated each child 4 times in 4 weekly intervals after admission and start of induction chemotherapy. To access the occurrence and severity of depression and to monitor progress during treatment we performed a psychiatric interview and also applied the psychiatric rating scale CDRS (Children's Depression Rating Scale) by Poznanski et al 1979 and SCMDD (Self-Report Symptom Checklist for Major Depressive Disorders) by Kashani et al 1985 derived from DSM III. 340 diagnostic ratings were performed by 3 raters; two of them were psychotherapeutically trained pediatricians (M. D., P. J. S.) and one psychologist (L. W.). A "clearcut" depression was found in 25 of the 340 ratings i.e. in 6 of the 34 children, demonstrating that the occurrence of depression in pediatric cancer patients was lower than primarily assumed.

[Ketamine anesthesia for outpatient procedures in children (author's transl)]. / Ketaminanaesthesie für ambulante Eingriffe bei Kindern.

Ketamine anesthesia was used in children to perform 200 outpatient procedures (mainly spinal taps, bone marrow aspirations and biopsies). Atropine was administered in advance and a ketamine dose of 1.8--2.0 mg/kg i.v. was sufficient in most instances. The general anesthesia allows calm and accurate performance of the necessary procedures. Ketamine can be used repeatedly and was preferred by the majority of children for subsequent procedures. The application of Diazepam (2 mg i.v. or 5 mg rectally) reduced unpleasant wake-up dreams in older children. The children were under close observation until consciousness was regained. They left the outpatient clinic attended by their parents approximately one hour after the procedure.